Gift From a Loving Husband: Part of Himself
New York Times: August 2, 2003
By RICHARD PÉREZ-PEÑA
In the annals of selfless devotion and far-fetched coincidence, no cheap paperback, no opera, no daytime soap has anything on the tale of Elena and Teddy Mocibob.
They don't quite look the part of the romantic leading lady and man right now, what with the tubes in their arms and the groggy, pained expressions, but they can be forgiven that. On Tuesday, surgeons at Westchester Medical Center in Valhalla removed Ms. Mocibob's diseased liver, cut out 60 percent of Mr. Mocibob's healthy one, and transplanted it into her. Without a new liver, doctors say, she had no more than two or three years to live.
To make the donation, Mr. Mocibob (pronounced MOH-chee-bob), 50, accepted a serious risk of illness and a slim chance of death from the surgery, and the certain knowledge that he would emerge from surgery with great pain from a foot-wide wound shaped like an upside-down "y" across his belly. Those were not his only sacrifices; he had to give up the cherished vices he acquired in his native Croatia: the cigarettes he had smoked for 35 years and the firewater he made, a home-brewed drink that he calls "Crazy H."
Yet sitting in his hospital bed Thursday, hoping to see his wife for the first time since the morning before the surgery, he dismissed the notion that he is any kind of hero. He did the best he could for her "because I love her," he said. "I would not go through this pain for fun. But what else could I do? I could not just lose her."
A minute later, Mr. Mocibob, a handyman and a landscaper who has lived in the United States for 21 years, tried to insist that he was merely being practical. "She can't work; she can't even wash the dishes," he said. "I work seven days a week. I'm poor. Maybe someday she can work."
Mrs. Mocibob, 43, took a different view. She was very weak even before the operation, and she underwent more than nine hours of surgery, twice the time her husband's operation took. Her speech was barely audible, punctuated by long pauses as she caught her breath and hunted for words through a narcotic fog. On a few topics, however, she was absolutely clear. A nurse's aide, she intends to work again after years of being too exhausted to leave home. She wants, more than anything, to have the energy to play with her grandchildren, ages 5 and 2, and to take them to the zoo. And she understands what her husband has done for her.
"He could have just thrown in the towel any time - a lot of men would," she said. "I know enough to know I don't want to live with a man who's going to have regrets afterwards. But it was his idea. He wanted to do it."
He wanted to, but it seemed unlikely at first that he could. When the Mocibobs, who live in Pleasant Valley, near Poughkeepsie, first explored the idea early this year, doctors said the odds were against his being a suitable donor. There was only a one-in-four chance that their blood types would match, and there were other reasons his liver might not have been right for her: it could have been too fatty, for example, or too large, or the risk to him might have been too great.
Live donor liver transplants are relatively uncommon. There are about 300 to 400 a year nationally, compared with about 5,000 from cadavers. Spouse-to-spouse transplants are rarer still, accounting for about 1 in every 300 live donations. As it turned out, this was that one, but the Mocibobs were no strangers to long odds. Mrs. Mocibob suffers from primary biliary cirrhosis, an autoimmune disorder that slowly destroys the liver, and afflicts 1 in every 20,000 people.She was one of thousands of people on transplant lists, waiting for the right organ to become available. About one in six people who need a new liver dies while waiting for one.
Most liver transplants involve whole organs taken from people who have died, and, in fact, the sickest patients need the entire liver. But the chronic shortage of dead donors has steadily increased the use of live transplants since the 1980's. A living donor gives up one of the liver's two lobes. Unlike other internal organs, a liver can regenerate, so in most live transplant cases, each lobe grows enough after surgery to give both donor and recipient full-sized, fully functioning livers. But the surgery is trickier, for both patients, than most organ transplants and comes with serious risks, a fact made clear last year, when a man died at Mount Sinai Medical Center in Manhattan after donating part of his liver to his brother.
"The risk of death to the donor is about 1 in 350, and there's about a 10 percent risk of complications" like bile leaks, bleeding and infections, said Dr. Patricia Sheiner, director of the liver transplant program at Westchester Medical, who took part in the operations on the Mocibobs. "And we tell them, `Don't expect to feel yourself for a few months.' "
This is the sort of complex, highly specialized care that used to be done almost exclusively by major urban hospitals, but that a growing number of suburban and small-city hospitals have taken up. Westchester Medical began doing kidney transplants in the late 1980's - it now performs more than any other hospital in the state - liver transplants in 1997, and heart transplants in 2001.
Teddy Mocibob, whose first name is Tarcizio, and his wife met in 1992. She was divorced, working in a supermarket and supporting four children, aged 3 to 14. She did not seem sick most of the time, but even then, she knew she was not quite right.
Mr. Mocibob likes to tease his wife by claiming that she knew she was sick when they met, and won his love under false pretenses. "She tricked me," he said. They lived in Yonkers. He did not drive then, so she drove him to and from work. (He has since learned.) Then came the days when she was too fatigued to drive.
In 1994, doctors found that her immune system was attacking her liver as if it were a foreign invader. If she did not have a transplant, she learned, the disease would lead to other ailments like osteoporosis and thyroid disease and, potentially, a host of autoimmune disorders like arthritis and diabetes. Eventually, it would kill her. She worked as long as she could, and took classes to become a certified nurse's aide, determined to work with the elderly. But by 1997, family members said, she barely had the energy to move around the house. In 1999, she and Mr. Mocibob married. "I always believed I'd get my liver," she said. "The Lord has too much work for me to do."
As Mrs. Mocibob's condition worsened, she entered a paradoxical phase of the disease. She would soon be sick enough to be placed near the top of the list to receive a liver from a dead donor, but she would also run the risk that no matching organ would become available in time to save her. She would also soon be too sick to be helped by a partial liver from a live donor.
Then Mr. Mocibob suggested that he give part of his own liver. Doctors told him that a blood test showed that he might be a compatible donor, but that they would not even consider him as a donor until he had stopped smoking for three months, and stopped drinking. He went cold turkey that day, Feb. 5, he said, quitting the Crazy H, the beer and the generic cigarettes he ordered by the carton over the Internet. He cannot swear that he will not want them back some day. Mrs. Mocibob knows what she wants. "My grandson, he goes, `Grandma, come play with me outside,' and I always have to say `No, I can't,' " she said. "I really want to play with my grandkids. I don't even know what it's going to feel like to be normal. I can't wait."
The Mocibobs hoped to see each other Thursday for the first time since the surgery, but they had to wait. Mr. Mocibob had a slight fever, and doctors could not take the chance that he might give some new illness to his wife. But by yesterday morning, his temperature was down, and he was bundled into a wheelchair to go to Mrs. Mocibob's room.
He wept when he saw her, unable to speak for a few minutes. He gripped her delicate hands in his thick ones and kissed them, and stroked her face. "It's been three whole days," he said when he finally found his voice. "So much has happened. I have so much to tell you."